Patients With Sepsis At Higher Risk Of Stroke, Heart Attack After Hospital Discharge

Houston, Texas, USA : Patients with sepsis are at increased risk of stroke or myocardial infarction (heart attack) in the first four weeks after hospital discharge, according to a large Taiwanese study published in CMAJ (Canadian Medical Association Journal).

Sepsis accounts for an estimated 8 million deaths worldwide, and in Canada causes more than half of all deaths from infectious diseases.

Researchers looked at data on more than 1 million people in Taiwan, of whom 42 316 patients had sepsis, matched with control patients in the hospital and the general population. All sepsis patients had at least one organ dysfunction, 35% were in the intensive care unit and 22% died within 30 days of admission.

They conducted a retrospective population-based cohort study comprising all patients who were admitted to a hospital in Taiwan with a diagnosis of sepsis and captured in the Longitudinal Health Insurance Database between Jan. 1, 2000, and Dec. 31, 2011.

They followed patients with a diagnosis of sepsis who were subsequently discharged from hospital for 4 outcomes: MI or stroke, termination of health insurance coverage, death or the end of the follow-up period. The follow-up period was determined to be 180 days, based on previous reports that the suspected risk of cardiovascular complications is minimal after 180 days.

They included patients with a diagnosis of sepsis who were identified via a validated method of administrative database extraction by searching for signs and symptoms consistent with the latest Sepsis-3 definition.

“Operationally, we defined sepsis as having codes from the clinical modification of the International Classification of Diseases, 9th revision (ICD-9-CM) for both an infectious process plus at least 1 diagnosis of acute organ dysfunction in the database record.” the researchers wrote

In the total group of patients with sepsis, 1012 had a cardiovascular event, 831 had a stroke and 184 had a myocardial infarction within 180 days of discharge from hospital.

Risk was highest in the first 7 days after discharge, with more than one-quarter (26%) of myocardial infarction or stroke occurring in the immediate period and 51% occurring within 35 days.

“We found that within the first 4 weeks after discharge from hospital was the critical period with a markedly elevated risk of [myocardial infarction] and stroke,” writes Dr. Chien-Chang Lee, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan, with coauthors.

The authors also found that younger patients with sepsis aged 20 to 45 years were at higher risk of heart attack or stroke compared to patients over age 75.

This study extends the findings of a Danish study that reported similar trends.

“Based on our study (Han Chinese) and the study in Denmark (European) that reported similar findings for two different ethnic groups, it is likely that these results are generalizable to different populations,” write the authors.

They call for further validation of their findings in different populations.

“We delineated the time-varying risk profile of MI and stroke after sepsis in a Taiwanese population. We found that within the first 4 weeks after discharge from hospital was the critical period with a markedly elevated risk of MI and stroke. Further validation of our findings in different populations is needed.” the researchers wrote

“This study was approved by the Institutional Review Board of National Taiwan University Hospital, Taipei, Taiwan. Patient consent was waived for this study because we used an electronic database in which data were anonymized.” the researchers wrote

Funding: This study was partially supported by Taiwan National Ministry of Science and Technology Grants MOST 104-2314-B-002-039-MY3, MOST 106-2811-B-002-048 and MOST 107-2314-B-002-196; and National Taiwan University Hospital Grants NTUH.106-P04, NTUH.107-P03 and NTUH.107-S3892.